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Many travelers misuse ‘standby’ antibiotics
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Travelers who carry “standby” antibiotics commonly use them in unwarranted situations, according to recently published findings. Moreover, they seek treatment for travelers’ diarrhea just as much as people who do not travel with emergency antibiotics, researchers reported in Travel Medicine and Infectious Disease.
Katri Vilkman, MD, of the department of bacteriology and immunology at the University of Helsinki, and colleagues said carrying standby antibiotics encourages travelers to be less cautious in using them.
Misuse of antibiotics is a main global driver of resistance.
“Travelers' diarrhea (TD) remains the most common health problem encountered by travelers to low-income regions,” Vilkman and colleagues wrote. “At present, its treatment is hotly debated. Traditionally, antibiotics used to be the mainstay of TD treatment, and even prophylaxis, yet recently the justification for this approach has been questioned due to the upsurge in antimicrobial resistance.”
In their study, Vilkman and colleagues assessed travel data from 316 volunteers with travelers’ diarrhea (TD) who were recruited at pre-travel visits to a travel clinic in Helsinki. They retrieved information on antibiotic use, standby antibiotic (SBA) carriage, and local health care visits from questionnaires and health diaries and identified factors linked to antibiotic use.
Of the 52 travelers who brought SBA for TD and who had complete data, 69% (36/52) never used them, 29% (15/52) used them for TD and 2% (1/52) used them to prevent skin infection. The criteria for severe TD were met by 36% (5/14) of the individuals who used SBA, whereas the remainder of the cases were classified as mild/moderate (64%). Approximately 54% (7/13) of travelers classified their TD as incapacitating, and the rest considered it nonincapacitating.
The rate of antibiotic use for nonsevere TD was significantly higher among SBA carriers (38%; 10/26) vs. non-SBA carriers (4%; 4.96; OR 14.4; 95% CI, 4.0-51.5), as was the rate of antibiotic use for nonincapacitating TD (SBA carriers, 29%; 7/24 vs. non-SBA carriers 5%; 5/95; OR: 7.4; 95% CI, 2.1-26.1).
Vilkman and colleagues looked for risk factors that would predispose SBA carriers to use SBA for TD and found that vomiting (OR 3.9; 95% CI, 1.1-14.3) was the lone factor.
The rate of TD-related health care visits did not differ significantly between SBA carriers (3.8%, 2/53) and noncarriers (6.1%, 13/212; OR 0.6; 95% CI, 0.1-2.7), Vilkman and colleagues reported.
“In our data, seeking medical care for TD while abroad led to antibiotic use without exception, and often to polypharmacy,” they wrote. “However, carrying SBA appeared not to prevent medical visits either. On the contrary, it encouraged less cautious use of antibiotics. Not only did SBA carriers resort more to antibiotics, but the drugs were mostly taken for nonsevere and nonincapacitating diarrhea. To cut back on unwarranted use of antibiotics for TD, new approaches need to be explored.” – by Jennifer Byrne
Disclosures: Vilkman reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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The International Society of Travel Medicine is addressing the problem of overuse of antibiotics in travelers through education of prescribers and travelers to use standby antibiotics for only moderate (interferes with itinerary) or severe (incapacitates) diarrhea, and not using antibiotics for milder illness. The study by Vilkman and colleagues confirms that we have a long way to go in such education. We are not at the point to recommend that travelers not carry antibiotics with them because these drugs are important, especially in treatment of severe and dysenteric disease. Antibiotics in this case should not be lumped together. Concern for development of resistance is seen primarily for the fluoroquinolones used to treat travelers’ diarrhea rather than poorly absorbed rifamycins.
References:
DuPont HL, et al. J Travel Med. 2018;doi:10.1093/jtm/taw054.
Riddle MS, et al. J Travel Med. 2018;doi:10.1093/jtm/tax026.
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